Acute Care/Hospitalization

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On account of prolonged waiting times for available hospital beds, emergency department (ED) clinicians often lack the luxury of triaging all patients with possible acute coronary syndrome (ACS, heart attack or unstable angina) to beds on cardiology units. The good news is that potential ACS patients triaged to noncardiology units fare as well in the short term as those triaged to cardiology units, according to a new study.

David A. Katz, M.D., M.Sc., of the University of Iowa, and colleagues compared the outcomes of 544 ED patients who were admitted to 2 university hospitals for symptoms of possible ACS (ranging from dizziness and nausea to chest pain and abdominal pain) after a nondiagnostic initial evaluation. They assessed 30-day adverse events, in-hospital treatment, and follow-up care by telephone interview 30 days later and medical record review.

One-third (34 percent) of admitted patients had confirmed ACS. The 372 patients admitted to cardiology units were nearly 3 times more likely to undergo evaluation for ischemic heart disease than the 172 patients admitted to general noncardiology units. Also, patients on cardiology units were more likely to receive recommended therapies such as aspirin, heparin, or beta-blockers (although none of these differences were statistically significant after risk adjustment).

Despite these differences in use of diagnostic procedures and treatment, admission to a cardiology unit did not translate into a significantly reduced incidence of adverse cardiovascular events, ED revisits or rehospitalizations, or better functional status at 30-day follow-up. The use of cardiology consultation in patients initially admitted to noncardiology units, which was a routine practice at both study hospitals, may have played a role in the similar outcomes of both patient groups. Also, ED physicians are well positioned to identify patients with multiple medical conditions and those with less clear-cut presentation, who may be more likely to benefit from generalist care. The study was supported in part by the Agency for Healthcare Research and Quality (HS10466).